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Saturday, June 25, 2016

The average Tennessean gets less then 3 active minutes per day. If exercise is a key cure for what ails you (see link and article below), then we need to do a significantly better job of building a city that makes active transport easy.

Hope for a better built environment came quickly in Mayor Barry's term when she signed an executive order for Nashville to build Complete and Green streets in May of 2016.

In fact, 'Metro Government has had a formal policy requiring that streets be designed to accommodate all modes of transportation since 2009, when Mayor Karl Dean issued the city’s inaugural Executive Order for Complete Streets'.

Therefore, it is a little confusing why we are still allowing options when important streets, such as 51st Avenue in The Nations, are being redesigned. Currently, 51st has 2 options on the table: one with bike lanes and one without. Councilwoman Mary Carolyn Roberts is deciding between the two...

If we are really honest and committed to Complete Street policy, this major road would have a bike lane. There wouldn't be a decision to make.

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As a pedestrian advocate, the addition of a bike lane to 51st Avenue has a lot of importance:

1. Slows Cut-through Traffic - when drivers have to account for bikes, in addition to other cars, it encourages them to slow down

3. Giving bicyclist a Safe Place to Ride discourages from using sidewalk or riding illegally (i.e. against traffic). I am not against bikes on sidewalks in some situations, but it is safer not to be surprised by bicycles when on foot.

4. Every person who bikes or walks is One Less Car in the queue at the stop light and one less parking spot taken. The debate over bike lanes on 51st is due to parking concerns.

5. The Nations is Flat - an easy and enjoyable bike ride! No joke, one of the reasons people sited for NOT biking is our many hills in Nashville. 51st Av is an ideal road for bike lanes as it is wide, long and flat. Add a B-cycle station or two and now you have a robust and vibrant center with healthy glowing locals. Win-win.

6. It would show that Nashville's commitment to Complete Streets is genuine and not just lip service.

Closest Thing to a Wonder Drug? Try Exercise

After I wrote last year that diet, not exercise, was the key to weight loss, I was troubled by how some readers took this to mean that exercise therefore had no value.

Nothing could be further from the truth. Of all the things we as physicians can recommend for health, few provide as much benefit as physical activity.

In 2015, the Academy of Medical Royal Colleges put out a report calling exercise a “miracle cure.” This isn’t a conclusion based simply on some cohort or case-control studies. There are many, many randomized controlled trials. A huge meta-analysis examined the effect of exercise therapy on outcomes in people with chronic diseases.

Let’s start with musculoskeletal diseases. Researchers found 32 trials looking specifically at the effect of exercise on pain and function of patients with osteoarthritis of the knee alone. That’s incredibly specific, and it’s impressive that so much research has focused on one topic.

Exercise improved those outcomes. Ten more studies showed, over all, that exercise therapy increases aerobic capacity and muscle strength in patients with rheumatoid arthritis. Other studies proved its benefits in other musculoskeletal conditions, like ankylosing spondylitis, and even some types of back pain.

For people (mostly middle-aged men) who had had a heart attack, exercise therapy reduced all causes of mortality by 27 percent and cardiac mortality by 31 percent. Fourteen additional controlled trials showed physiological benefits in those with heart failure. Exercise has also been shown to lower blood pressure in patients with hypertension, and improve cholesterol and triglyceride levels.

People with diabetes who exercise have lower HbA1c values, which is the marker of blood sugar control, low enough to probably reduce the risk of complications from the disease. Twenty randomized controlled trials have showed that patients with chronic obstructive pulmonary disease can walk farther and function better if they exercise.

Multiple studies have found that exercise improves physical function and health-related quality of life in people who have Parkinson’s disease. Six more studies showed that exercise improves muscle power and mobility-related activities in people with multiple sclerosis. It also appeared to improve those patients’ moods.

The overall results of 23 randomized controlled trials showed that exercise most likely improves the symptoms of depression. Five others appear to show that it improves symptoms in patients with chronic fatigue syndrome. In trials, exercise even lessened fatigue in patients who were having therapy for cancer.

What other intervention can claim results like these?

Even studies of older, hospitalized patients show a beneficial effect from multidisciplinary interventions that include exercise. Those randomized to such interventions in the hospital were more likely to be discharged to go home, and to spend less time in the hospital over all — and at a lower cost.

Although we don’t think of it this way, you can make a pretty good argument that exercise is as good as drugs for many conditions. A 2013 meta-analysis of meta-analyses (that’s how much data we have) combined and analyzed the results from 16 reviews of randomized controlled trials of drug and exercise interventions in reducing mortality. Collectively, these included 305 trials with almost 340,000 participants.

Diuretic drugs (but not all drugs) were shown to be superior to exercise in preventing death from heart failure. But exercise was found to be equally good as drugs in preventing mortality from coronary heart disease. Exercise was better than drugs in preventing death among patients from strokes.

Many people will be surprised at how little you need to do to achieve these results. Years ago, in an effort to get in shape, I tried the P90Xroutine. It proved too hard for me. Later, when I tried the Insanityworkout, it beat me so badly that people at work kept asking me if I was ill. Two years ago, I tried P90X3. It was a bit more manageable, but I still couldn’t keep it up.

I have not been alone in thinking that physical activity to improve health should be hard. When I hear friends talk about exercising, they discuss running marathons, participating in CrossFit classes or sacrificing themselves on the altar of SoulCycle. That misses the point, unfortunately. All of these are much more than you need to do to get the benefits I’ve described.

The recommendations for exercise are 150 minutes per week of moderate intensity physical activity for adults, or about 30 minutes each weekday.

Moderate intensity is probably much less than you think. Walking briskly, at 3 to 4 miles per hour or so, qualifies. So does bicycling slower than 10 miles an hour. Anything that gets your heart rate somewhere between 110 and 140 beats per minute is enough. Even vacuuming, mowing the lawn or walking your dog might qualify.

Today, my goals are much more modest. Trekking from my office to the clinic and back again gives me 30 minutes of exercise. Or, I walk to the supermarket from my office to grab lunch, at a mile each way. In colder weather, I spend half an hour on the elliptical machine. Doing this five days a week gets me the activity I need.

Although it feels as if there’s nothing we can do to change people’s behavior, there is evidence to the contrary. A systematic review and meta-analysis of advice and counseling by health professionals found that promotion of physical activity works.

Doctors and clinics that made efforts to promote exercise to patients needed to engage 12 adults on the subject to get one additional adult to meet recommended levels of activity one year later. That might not sound impressive, but it’s one of the better such results.

After the Academy of Medical Royal Colleges wrote its report, an editorial in the BMJ, a prominent medical journal, countered that exercise wasn’t a “miracle cure.” Instead, the authors argued it was “the best buy for public health.”

If that’s the best “counterpoint,” then physical activity seems like a no-brainer.

Monday, June 13, 2016

In my part of Nashville, between Vanderbilt and Green Hills, when talking about walkability/sidewalk implementation, I often hear people say, 'It's suburban, there is not much that can be done'.

For the record, with the growth of the city & the amount of traffic we endure, we don't feel suburban. And, we want to be able to walk, use the bus, ride our bikes, too.

If you live in the Urban Service District, by its very definition, you are not suburban. You are urban. Please don't use the term 'suburban' as the excuse to not modernize. Let's put the infrastructure, such as sidewalks, in when the construction crew is already there.

As we experience our boom in growth, now is the time for these things. It won't be any easier afterwards...and, it won't be cheaper or less messy.

Friday, June 10, 2016

Shade Parade has always been a bit of an art project for me. Before medical school, I went to art school and therefore enjoy this kind of creative outlet. Considering ways to make Nashville more walking-friendly is a naturally inspiring as there is so much potential here!

I am also a big fan of serendipity...probably one of my main reasons for loving walking is the surprise of what you may come across while out on foot: a friend, a mural, a beautiful tree, or a Little Library with the summer read of your dreams.

In the spirit of serendipity, I hope Nashvillians consider buying an extra copy of their favorite books and leave them in surprising places...

You are encouraged to go through your books and music so they can be shared in a Little Library!

I bought an extra copy of this book below this morning to share in my local Little Library. Hope you are the one to find it...

Friday, June 3, 2016

I am currently working on a new concept called Walking Districts. Designed for local streets that are highly walked but have a low Sidewalk Priority Index (SPI) score. With our current system of using the SPI, these areas would be last on the list of sidewalk creation. And, maybe rightfully so. The areas I am talking about are low volume in vehicular traffic neighborhoods and many have a park-like feel.

The concept entails 3 things making it a quick, easy, and inexpensive fix. The first is signage: a sign announcing that you are entering a Walking District. The second is a street decal (think of the bicycle decal you see on roadways but change it to a pedestrian). The third is a speed limit reduction to 20mph.

I know it isn't perfect but it is doable. And, it could get the ball rolling for Nashville to be a great walking city, particularly if rolled out with Public Awareness Campaign on Pedestrian Rights.

The loop in my neighborhood of Gold Club, Woodleigh, Forrest Park and Timber is, for example, highly walked for its fairly quite streets and thick tree coverage. It already has a great park-like feel which is appealing to walkers. But, the roadway is narrow and the speed limit is 30mph. So, when walking, one has to often either wave to make sure driver has seen you or head off the road into the grass for safety.

Why not flip this, so that the pedestrian has the advantage? Some of these roads I have mentioned are 2 blocks long (& loaded with children). Does anyone really need to drive 30+ mph?

I like to think of this project as a 'Greenway Extender' - a way to create a Greenway-like space in an already well walked neighborhood with only minor changes.

Dear ___

I am writing to ask for your support for the concept of Walking Districts in Nashville.As Nashville grows, the demand for walkability increases. Traffic and increased density are major concerns to many. Inability to walk to public transportation, shopping or other areas of interests due to lack of safe sidewalk options is noteworthy in many areas. In addition, the ability to access Greenways, parks and schools often requires a car ride prior to launching out on foot. As you are well aware, the city is behind in regards to walking infrastructure and cost to build sidewalks is a sizable burden.

In September 2015, the US Surgeon General announced a national Call to Action, urging cities and towns to consider how the design of our roads and public spaces can encourage more walking by making it easier, safer and more convenient. While we wait for sidewalks, to further the goal of making Nashville a safe and active walking city, consider a proposal that would vastly improve our current situation for little cost. The proposal would reconceptualize select streets that are currently at the bottom of The Sidewalk Priority Index according to The Nashville-Davidson County Strategic Plan for Sidewalks and Bikeways into 'Walking Districts'.

The project entails 3 simple changes: signage announcing area to be a 'Walking District', pedestrian decals on the roadway akin to those utilized for bikeways, and a speed limit reduction to 20mph.

This proposal allows for certain key roads to be repurposed into 'Walking Districts'. The roads could be strategically chosen based on their proximity to schools, parks, shopping or Greenways, their popularity as deemed by pedestrians or neighborhood associations, their residential nature or other points of interest.

Envision this as a way to motivate Nashvillians to get active. According to the CDC website, 62.1% of adults in Nashville/Davidson County are considered overweight or obese and 50% of adolescents. Average active minutes are reported at a dismal 4 per day. Envision this as a possible Greenway extender. This could be a way to safelyusherneighbors onto the Greenway and eliminate the need to drive to the park. In a similar fashion, this could allow for elevated utilization of public transportation. Envision this as a way to allow people to safely and comfortably walk to public transportation.

Consider the impact on public safety. Crash data supports the average risk of severe injury to a pedestrian struck by a vehicle reaches 10% at 16mph, 25% at 23mph and 50% at 31mph. Similarly, death occurs 10% of the time at 23mph, 25% at 32mph and 50% at 42mph (AAA data, 2011). Smart Growth for America rates Nashville the 15th most dangerous city in the US for pedestrians which stands in stark opposition to our popularity in many other domains.

Presumably, these roads we are proposing may never get sidewalks and we understand that. Since they are mainly in residential neighborhoods, people currently use them to go for a walk, visit their neighbors and connect to the busier collector and arterial streets. But without sidewalks, they are unsafe and uncomfortable when shared with vehicular traffic traveling through at 30 mph. With the enhanced safety, we believe that you will see many more people including children and elderly walking in their own neighborhoods and engaging with active transportation options.

Thursday, June 2, 2016

Everyday, I hear of someone interesting moving to Nashville. Our little city is on fire and it is wonderful!

From The New Yorker, Goings on About Town:Adia Victoria's powerful 2016 B-side 'Howling' Shame' lurches through foggy, spellbinding guitar and violin like the withered woman described in its lyrics. Raised in South Carolina as a Seventh-Day Adventist, the twenty-nine-year-old tried out New York, then settled in Nashville to live 'like a voyeur'.

The new Nashvillians are so fresh and vibrant...and, they are flocking to walkable neighborhoods. But, there has been a real challenge in Nashville as we do not have a city wide movement to build sidewalks. Our sidewalk budget is 50/50 new/maintenance of old. Developers are not building the infrastructure to help rapidly changing neighborhoods be walkable. And, they are not paying the Sidewalk In-Lieu fee to help these areas in the future either. We have whole neighborhoods that are sandwiched between busy 'centers' but you cannot get out of them on foot without risking your life - so called 'Walking Deserts'. Traffic is mounting - we are in an uncomfortable pinch.

The darkest shape is a single district in Nashville: check out the huge disparity in proposed sidewalks when comparing the northern part vs the southern part. This is a 'Walking Desert'

The fact is, we all will welcome, adjust or move...Nashvillans span the gamut in their responses to the growth of our city. When discussing sidewalk advocacy, many ask, 'who could be against sidewalks'? You'd be surprised...

'Like an ocean liner: you turn the wheel slowly, and the big ship pivots'. 'People may feel like we need a fifty-degree turn; we don't need a two-degree turn. And you say, 'Well, if I turn fifty degrees, the whole ship turns over'. - President ObamaThis is how many feel about sidewalks...we need the fifty degree turn. We just completed the tasks required from our big ADA lawsuit back in 1999...so, maybe the sidewalk budget can shift away from being 50% for new and 50% for repairs? Maybe we can stop fixing perfectly fine sidewalks (hello Natchez, hello also to the sidewalk in front of Climb Nashville) and starting building some new ones in areas that REALLY NEED them?Maybe, like other big civic projects (yes, baseball stadium, I do mean you), we can commit to creating a culture of walking here in Nashville. We can build well-designed, tree-lined sidewalks, create Walking Districts, implement Vision Zero, have a 'pedestrians first' attitude + public awareness campaign...it could be HUGE!Vote now for where you would like to see a sidewalk: